The prognosis for vulvar cancer depends on several factors—cell type, stage (which emphasizes local tumor extent), the presence or absence of groin node metastases, the size of the lesion , the depth of invasion, whether blood or lymphatic vessels are involved, the grade of the tumor and the pattern of invasion.
At diagnosis, about 35 percent of all vulvar carcinomas are Stage I, 30 percent of women have Stage II, 25 percent have Stage III and 10 percent have Stage IV disease. The overall five-year survival rate for all women with invasive squamous cell carcinoma of the vulva is 69 percent.
Surgery The standard therapy for the past four decades has been radical surgical excision of the
vulva and the removal of the lymph nodes in the groin and, occasionally, the pelvis. External beam radiation therapy is frequently given to the groin and pelvis after surgery to women with positive groin and/or pelvic lymph nodes on one or both sides.
Over the past 15 years, less radical surgery and the removal of the groin nodes on one side has been shown to be equally effective in small, early-stage disease. Despite this trend toward conservative therapy, experience has taught that limiting surgery because of advanced age or frailty can result in overwhelming problems with locally advanced recurrent cancer in women who have lived longer than expected.
A radical vulvectomy and groin dissection is extraordinarily well tolerated and can be done in phases if the patient's medical condition warrants. Whether sexual function returns depends on the extent of surgery and radiation therapy. Sexual function is also surprisingly more satisfactory than one would think.
